Culture medium and a method for detection of parasites

ABSTRACT

This invention relates to a culture medium, a kit containing the culture medium and to a method for detection of a parasite such as  Dientamoeba fragilis  and/or another parasite. The culture medium of the invention is bi-phasic and includes a solid phase containing an egg slope or agar slope; and a liquid phase including a serum and a peptone.

FIELD OF THE INVENTION

This invention relates to a culture medium, a kit containing the culturemedium and to a method for detection of a parasite such as Dientamoebafragilis and/or another parasite.

BACKGROUND

Dientamoeba fragilis (D. fragilis) is one of the most common parasitesaffecting animals including humans. It is thought to be spread viapinworms acquired by the faecal/oral route and resides in thegastrointestinal tract of the host, clinically causing such symptoms asabdominal discomfort, loose motions, bloating, diarrhoea, at timesnausea, pruritus ani, malaise and other non specific symptoms. It isperhaps one of the most common parasites residing in thegastrointestinal tract of individuals in the western world and yet fewphysicians are aware of its presence and its contribution to disease,chiefly due to the fact that it is not diagnosed frequently.

Dientamoeba fragilis is notoriously difficult to diagnose unlesssuitable fixatives and permanent staining methods are employed andadequately trained personnel are available (Windsor and Johnson1999-Windsor J J, Johnson E H. Dientamoeba fragilis: the unflagellatedhuman flagellate. A review. Br J Biomed Sci 1999; 56:293-306). Culturemethods have been shown to be more sensitive than microscopy at times(Ockert 1990, Sawangjaroen 1993-Ockert G. Symptomatology, pathology,epidemiology and diagnosis of Dientamoeba fragilis: In: Honiberg B M, edTrichomonads parasitic in humans. New York; Springer 1990; 394-410),however these culture methods are not currently used in diagnosticlaboratories because of their complexity.

If the methodology could be simplified, culture would be more easy toperform and would have the added advantage that the isolates can belysed and typed, thus aiding future epidemiological studies on top ofsimple diagnostic studies. D fragilis does not have a resistant cyststage and consequently cannot survive outside the human host for longerthan 12 hours (Sawangjaroen 1993-Sawangjaroen N, Luke R, Provic P.Diagnosis by faecal culture of Dientamoeba fragilis in Australianpatients with diarrhoea. Trans Roy Soc Trop Med Hyg 1993;87:163-5). Inorder for the culture method to be successful, the culture medium needsto be simple and needs to be one that will support the growth of D.fragilis and other parasites, eg Blastocystis hominis. Furthermore, themedium needs to have the features of long shelf life andtransportability. In addition, the detection of the growing parasitesneeds to be carried out easily by technicians with minimal training.Previous methods have included specific stains, eg., trichome andiron-haematoxylin, and more recently Riordan (U.S. Pat. No. 5,334,509)has suggested an acridine orange or acridine yellow stain for morespecifically detecting D. fragilis. However, this method lacksspecificity as it merely stains up RNA/DNA and therefore stains numerousparasites, including non-pathogenic ones. Using this method D. fragilisis at times indistinguishable microscopically from such parasites, andso the diagnosis again depends on the availability of highly trainedmicroscopists to diagnose D. fragilis.

It would also be desirable to simplify the culture medium so that it canbe used by an unskilled technician.

SUMMARY OF THE INVENTION

It is the object of the present invention to overcome or substantiallyameliorate at least one of the above described disadvantages.

According to a first aspect of the invention, there is provided abi-phasic culture medium including

a solid phase containing an egg slope or agar slope; and

a liquid phase including a serum and a peptone.

In one embodiment, the solid phase is an egg slope.

In one embodiment, the serum is horse serum.

In one embodiment, the serum is rabbit serum.

In one embodiment, the peptone is bactopeptone.

In one embodiment, the liquid phase includes a phosphate buffered salinehaving a pH of from about 6.8 to about 7.8. Suitably the liquid phasecontains up to about 98 vol % of the phosphate buffered saline, about 1to about 15 vol % of the serum, and about 1 to about 15 vol % ofbactopeptone (about 1 to about 40 w/w), in the liquid phase. The mediummay also include an antibiotic from the class of macrolides,penicillins, cephalosporins, quinolones, aminoglycosides or otherantibiotics. Suitably more than one antibiotic can be present. Suitableantibiotics include erythromycin, penicillin, streptomycin, clindamycin,cephalexin, vancomycin, rifampicin. Suitably a tetracycline is not used.

According to a second aspect, there is provided a kit including acontainer containing the medium according to the first aspect togetherwith a container containing rice starch.

In one embodiment the kit includes a compartmentalized specimen bag. Thekit may further include a utensil such as spoon or scoop fortransferring a specimen such as faecal matter into the containercontaining the medium. An additional container may also be provided forcontaining a specimen.

Suitably the container containing rice starch is a sachet.

According to a third aspect, there is provided a method of detecting thepresence of a protozoa in a specimen, said method including

adding to the medium according to the first aspect, said specimen, ricestarch and where necessary, an antibiotic,

allowing the medium to incubate for a time period so as to cultivateprotozoa,

examining at least a portion of the incubated medium to detect thepresence of protozoa.

Suitably the portion examined is or includes sediment.

According to a fourth aspect, there is provided a method of detectingprotozoa in faecal matter, said method including adding to the mediumaccording to the first aspect, faecal matter, rice starch and wherenecessary an antibiotic,

-   -   allowing the medium to incubate for a time period so as to        cultivate intestinal protozoa,    -   examining at least a portion of the incubated medium to detect        the presence of said protozoa.

Suitably the portion examined is or includes sediment.

Suitably the protozoa detected are one or more of Dientamoeba fragilis,Blastocystis hominis, E. histolytica/dispar, Iodamoeba butschlii,Endolimax nana, Entamoeba coli, or Entamoeba hartmanni. Most suitablyDientamoeba fragilis. Other suitably protozoa include protozoa of thegenus referred to above, such as Dientamoeba spp, Blastocystis spp,Entamoeba spp or Iodamoeba spp. Suitably the portion of the sediment isexamined microscopically, although a portion of the sediment can bestained and examined for various protozoa.

In one embodiment the medium is incubated for a period of up to 4 days.In another embodiment the medium is incubated for up to 48 hours. Ifdesired, additional antibiotic and/or rice starch can be added duringthe incubation period such as after 24 hours of incubation. Suitably themedium is incubated at a temperature of about 36° C. to about 38° C. Forexample, the temperature may be about 36° C., about 36.5° C., about 37°C., about 37.5° C., or about 38° C. Suitably the antibiotic is one ormore antibiotics selected from the antibiotics listed above and issuitably one selected from the group consisting of erythromycin,penicillin, streptomycin, clindamycin, cephalexin, vancomycin andrifampicin.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 shows a kit in accordance with one embodiment of the invention.

DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION

In the present invention the culture method and medium has beensimplified to a less complex medium but one that will in use, supportthe growth of the protozoa referred above including D fragilis,Blastocystis hominis (B. hominis) and other parasites including otheramoebae (for example E. histolytica/dispar, Iodamoeba butschliiEndolimax nana, Entamoeba coli, Entamoeba hartinanni being otherpathogens). The medium in accordance with the invention can double as atransport medium where a sample is taken off-site from the laboratoryand then transported to the laboratory. The culture medium preferablyuses an egg slope as opposed to previous used saline agar cultures. Theegg slope may be made by any appropriate method known in the art, forexample by diluting hen's eggs 50/50 in either Ringer's salt solution orPBS (phosphate buffered saline). The culture medium of the inventiondemonstrates enhanced reliability of culture. The medium is not ascomplex as those described in the prior art which comprise numerouschemicals. The medium in accordance with the present invention is—byculture standards—greatly simplified yet more reliable. Unlike the useof live E. coli bacteria (which are not suitable to be given to patientsin order to collect their own specimens), the medium in accordance withthe invention is designed to work even more reliably without E. coli.

In addition to the egg or agar slope, the culture medium also contains aliquid phase which includes a serum such as rabbit or horse serum and apeptone such as bactopeptone or bacteriological grade peptone. Typicallythe liquid phase which is suitably saline and suitably has a pH of fromabout 6.8 to about 7.8 (more typically about 7.4), contains the peptonein an amount of from about 1 to about 40 vol %, preferably about 20 vol%. Suitably in a 100 ml formulation of the liquid phase, about 1 to 15mls, suitably about 5 mls of the peptone, suitably a bactopeptonesolution is used.

The present invention also provides a kit designed to allow a samplesuch as faecal matter to be placed immediately into the culture mediumby the patient. One preferred form of a kit in accordance with theinvention is shown in FIG. 1. In FIG. 1, the kit 1 may be in the form ofa compartmentalized specimen bag 2 suitably containing fourcompartments. One compartment contains a specimen container 3 or bottlefor collecting a sample such as faeces. A second compartment contains autensil such as a scoop or spoon 4, suitably a plastic spoon. A thirdcompartment contains a container 5, suitably a sachet containing ricestarch. A final container 6 containing the culture medium in accordancewith the invention is provided in a fourth compartment.

In use, a patient collects a specimen such as faeces into the container3. The faecal matter includes for example stool sample, lumina contentsor colonoscopy aquired material. A small portion (suitably pea-size) ofthe specimen is then transferred by means of the scoop 4 and inoculatedinto the culture medium in container 6. The scoop can either then bediscarded or resealed in the second compartment and discarded at thelaboratory. Rice starch from container 5 is then added to the medium incontainer 6. Then, the culture medium is suitably transported to thelaboratory for incubation while the protozoa such as D fragilis andother parasites survive the transportation due to the unique nature ofthe medium which can also double as a transport medium. A “pea-size”amount of stool is required only and it is placed into the culturemedium with the contents of the enclosed sachet, added to make thetransport/culture simplified. Left over faecal matter can be used forculture and sensitivity (C & S) and other parasites (parasite OVA).

The culture medium is bi-phasic and consists of a solid phase (the eggand/or agar slope) in a liquid phase. The liquid formulation per 100 mlstypically includes about 90 mls Phosphate Buffered Saline pH 7.4(suitable range about 6.8-7.8), about 5 mls of serum, such as sterileHorse serum (suitable range about 1-15 mls) and about 5 mls 20% ofpeptone such as bactopeptone (suitable range about 1-15 mls). Suitablyabout five drops (suitable range about 1 to 10 drops) of an antibioticsuch as about 0.5 wt % erythromycin (suitable range about 0.015 wt % to30 wt %) is added to the culture medium and a small amount of ricestarch for example an amount of about 10 mg to about 100 mg, is alsoadded suitably from the sachet. Rice starch is essential for the xeniccultivation of intestinal protozoa (Clark and Diamond 2002—Clark C G,Diamond L S. Methods for the cultivation of luminal parasitic protestsof clinical importance. Clinical Microbiology Reviews 2002; 15:329-341).Once the specimen is added to the medium it is incubated at 37° C. for24 hours suitably in a laboratory (suitably at a temperature in therange of about 36° C. to about 38° C.). Then an extra two drops(suitable range 1 to 5 extra drops) of the antibiotic such aserythromycin are suitably added together with a small amount of ricestarch, and a further incubation is suitably carried out for about 24hours (suitably about 48 hours incubation in total) before examinationsuitably under a microscope is carried out. Further examinations may becarried out at 3 and finally at 4 days to allow for the occasionaldetection of slow-growing parasites which may include, for example oneor more of D. fragilis, B. hominis, E. histolytica/dispar, Iodamoebabutschlii, Endolimax nana, Entamoeba coli, and Entamoeba hartmanni. Whenexamined microscopically, a drop of sediment is examined using the X20objective of the microscope for the typical morphology of variousprotozoa. D fragilis ingests the rice starch voraciously,differentiating it from B hominis when viewed under the microscope.Under microscopic observation D. fragilis appear as round, refractilebodies packed with rice starch. Other intestinal amoebas such asEntamoeba and Iodamoeba also ingest rice starch, but D fragilis producescharacteristic pseudopodia after 10-20 minutes at room temperature.These pseudopodia are leaf-like and are easily distinguishable fromthose produced by Entamoeba. Positive cultures can be simply confirmedby making a smear of the deposit, allowing it to air dry and fixing itin industrial methylated spirit or ethanol. This then can be stainedwith Giemsa (10% in PBS (phosphate buffered saline) pH6.8) for 20minutes with a wash of buffer before examining under the microscope.

Other parasites and mixed infections may also be detected using theculture method of the invention. Any parasite growing in the culture canbe identified by using simple stain. Entamoeba sp grow much larger thanD. fragilis and the pseudopodia are much more obvious and larger. Anyquery regarding E. histolytica/dispar isolates can be resolved by lysingusing 0.25 ml 0.25% SDS containing 0.1 M EDTA and conducting a specificPCR/ELISA to confirm/exclude the pathogenic E. histolytica. Similarly,B. hominis can be detected using this culture. Although thepathogenicity of this parasite is controversial it has been associatedwith Irritable Bowel Syndrome. (IBS). It is possible that a certainsubtype of B. hominis may be linked with disease, again a lysate can bemade and then typed using riboprinting—Clark C G. Riboprinting: a toolfor the study of genetic diversity in microorganisms. J Euk Microbiol1997; 44: 277-83.

By use of the invention it is possible to detect protozoa including D.fragilis in a simple manner.

The invention will now be described with reference to the followingexamples

CLINICAL EXAMPLES Example 1

In a 34 y old female suffering with longstanding loose motions, wind andmild bloating a clinical diagnosis of “Irritable Bowel Syndrome” wasmade. To exclude enteric parasitic infestation, a stool test was orderedby the patient's physician. A faecal sample was collected by the patientusing a small scoop provided in the kit in accordance with oneembodiment of the present invention. A pea-sized amount of stool wasplaced into the culture medium of the invention, which in this casealready contained the erythromycin. The contents of a sachet containingrice starch was also added. The specimen was taken to the laboratorywhere it was incubated for 24 hours at 37° C. A small amount of ricestarch was later added as well as 2 drops of erythromycin and theculture incubated a further 24 hours. A drop of the sediment wastransferred onto a glass slide and a coverslip added. This preparationwas examined under a light microscope using x20 objective. Round,refractile bodies that had ingested rice starch granules and produceddelicate leaf-like pseudopodia after 10-20 minutes at room temperaturewere identified and a presumptive diagnosis of D. fragilis was made. Asmear was made, allowed to air-dry, fixed in IMS (industrial methylatedspirits) and was simply stained with Giesma for confirmation. Thepatient was treated with the appropriate anti-parasitic therapy andrecovered.

Example 2

In a 49 y old male patient with a family history of bowel malignancy,complaining of marked flatulence and hepatic flexure cramping pain, acolonoscopy was carried out to exclude the presence of bowel cancer.Simultaneously a sample of lumina contents was collected by aspiration.The colonoscopy acquired material was collected into the specialisedfaecal container of the invention and a small portion was transferredinto the culture medium of the invention. The contents of a sachetprovided in the kit in accordance with one embodiment of the inventioncontaining rice starch was also added to the medium. The specimen wastransported to the laboratory where it was incubated for 24 hours at 37°C. A further small amount of rice starch was then added together with 2drops of erythromycin and the culture was incubated for a further 24hours. A drop of the sediment was transferred onto a glass slide and acover slip added. This preparation was examined under a light microscopeusing x20 objective. Round, retractile bodies that ingest rice starchgranules and produce delicate leaf-like pseudopodia after 10-20 minutesat room temperature were detected and a presumptive diagnosis of D.fragilis was made. A smear was made, allowed to air-dry, fixed inindustrial methylated spirits (IMS) and simply stained with Giemsa forconfirmation.

Example 3

A female patient 39 y of age presented with long standinggastrointestinal symptoms including abdominal pain, flatulence,distention, nausea and minimal weight loss. Repeated faecal samples werenegative at the local hospital microbiology laboratory. In the mostrecent stool sample refractile bodies were observed using directmicroscopy, although these could not be identified and did not show upin the parasite concentration method. The laboratory concerned did notuse permanent faecal stains e.g. trichrome or iron-haematoxylin. This isa common feature in Australia and the UK, where very few routinelaboratories employ such methodologies. Part of the specimen wastransferred into the culture medium of the present invention, using thesmall scoop provided within the kit of one embodiment of the invention.The contents of a sachet containing rice starch was also added to themedium. The specimen was transported to the laboratory where it wasincubated for 24 hours at 37° C. A further small amount of rice starchwas then added together with 2 drops of erythromycin and the culture wasincubated for a further 24 hours. A drop of the sediment was transferredonto a glass slide and a cover slip added. The preparation was thenexamined under a light microscope using x20 objective. Microscopicanalysis showed numerous refractile bodies, some of which ingested therice starch. The Giemsa stain demonstrated the presence of both D.fragilis and B. hominis, a common finding in patients presenting withIBS-like symptoms.

In the above examples, detection is by standard methods using microscopywith special stains. The components of the formulations used can besourced from many sources including Sigma Chemicals.

Although the invention is described in terms of various embodiments, itwill be readily appreciated by those skilled in the art that variousmodifications, rearrangements and substitutions can be made withoutdeparting from the spirit of the invention.

1. A bi-phasic culture medium, comprising: a solid phase containing an egg slope or agar slope; and a liquid phase including a serum and a peptone.
 2. The medium of claim 1, wherein the solid phase is an egg slope.
 3. The medium of claim 1, wherein the serum is horse serum or rabbit serum.
 4. The medium of claim 1, wherein the peptone is peptone or bactopeptone.
 5. The medium of claim 1, wherein the liquid phase includes a phosphate buffered saline having a pH of from about 6.8 to about 7.8.
 6. The medium of claim 5 containing up to about 98 vol % phosphate buffered saline in the liquid phase.
 7. The medium of claim 1, wherein the liquid phase contains about 1 to about 15 vol % of serum.
 8. The medium of claim 1, wherein the peptone is an about 1 to about 40 w/w % bactopeptone solution.
 9. The medium of claim 1, wherein the liquid phase contains about 1 to about 15 vol % of the peptone.
 10. The medium of claim 1, further including an antibiotic.
 11. The medium of claim 10, wherein the antibiotic is selected from the group consisting of erythromycin, penicillin, streptomycin, clindamycin, cephalexin, vancomycin and rifampicin.
 12. (canceled)
 13. A kit, comprising: a container containing the medium according to any one of the preceding claims of claim 1; and a container containing rice starch.
 14. The kit of claim 13 which is contained in a compartmentalized specimen bag.
 15. The kit of claim 13, further including a utensil for transferring a specimen into the container containing the medium.
 16. The kit of claim 13 including an additional container for containing a specimen.
 17. The kit of claim 13 wherein the container containing rice starch is a sachet.
 18. (canceled)
 19. A method of detecting the presence of protozoa in a specimen, the method including: adding to the medium of claim 1, the specimen, rice starch and where necessary, an antibiotic; allowing the medium to incubate for a time period so as to cultivate protozoa; and examining at least a portion of the incubated medium to detect the presence of protozoa.
 20. A method of detecting protozoa in faecal matter, comprising: adding to the medium of claim 1 faecal matter, rice starch and where necessary, an antibiotic; allowing the medium to incubate for a time period so as to cultivate intestinal protozoa; and examining at least a portion of the incubated medium to detect the presence of the protozoa.
 21. The method of 19, wherein the protozoa detected is one or more of Dientamoeba fragilis, Blastocystis hominis, E. histolytica/dispar, Entamoeba or Iodamoeba, Iodamoeba butschlii, Endolimax nana, Entamoeba coli, or Entamoeba hartmanni.
 22. The method of claim 21 wherein the protozoa detected is Dientamoeba fragilis.
 23. The method of claim 19, wherein the medium is incubated for a period of up to about 4 days.
 24. The method of claim 19, wherein the medium is incubated for up to about 48 hours.
 25. The method of claim 19, wherein additional antibiotic and/or rice starch are added after about 24 hours of incubation.
 26. The method of claim 19, wherein the medium is incubated at a temperature in the range of 36° C. to 38° C.
 27. The method of claim 19, wherein the portion of the incubated medium is examined microscopically.
 28. The method of claim 19, wherein the antibiotic is erythromycin.
 29. The method of claim 19, wherein the portion is or includes sediment.
 30. (canceled)
 31. The method of claim 20, wherein the protozoa detected is one or more of Dientamoeba fragilis, Blastocystis hominis, E. histolytica/dispar, Entamoeba or Iodamoeba, Iodamoeba butschlii, Endolimax nana, Entamoeba coli, or Entamoeba hartmanni.
 32. The method of claim 20, wherein the medium is incubated for a period of up to about 4 days.
 33. The method of claim 20, wherein additional antibiotic and/or rice starch are added after about 24 hours of incubation.
 34. The method of claim 20, wherein the medium is incubated at a temperature in the range of 36° C. to 38° C.
 35. The method of claim 20, wherein the portion of the incubated medium is examined microscopically.
 36. The method of claim 20, wherein the antibiotic is erythromycin.
 37. The method of claim 20, wherein the portion is or includes sediment. 